Correlation between serum cardiac markers and myocardial infarct size quantified by myocardial perfusion imaging in patients with hypertrophic cardiomyopathy after alcohol septal ablation.

Myocardial infarct (MI) size is a well-established prognostic marker but the association of serum markers with MI size, as measured by myocardial perfusion imaging (MPI), has not been well studied in patients with hypertrophic cardiomyopathy (HC) after alcohol septal ablation (ASA). Creatine kinase (CK), CK-MB, troponin I, and brain natriuretic peptide were measured before and at multiple points after ASA in patients with HC and were correlated with MI size measured by MPI. MPI at rest was performed in 54 patients with HC at a median of 2 days after ASA.

How much alcohol should we infuse in the coronary artery of hypertrophic cardiomyopathy patients?

Background: Although alcohol septal ablation (ASA) is increasingly used in hypertrophic cardiomyopathy (HC) patients who are refractory to medical therapy, the amount of alcohol that is required has not been well studied. This study sought to determine the amount of alcohol that is necessary to achieve clinical benefits of ASA.

Methods: Myocardial perfusion imaging was used to determine the size of the myocardial infarction produced by ASA in 54 HC patients.

The value of live/real time three-dimensional transesophageal echocardiography in the assessment of valvular vegetations.

We studied 13 patients with valvular vegetations who underwent intraoperative live/real time three-dimensional transesophageal echocardiography (3DTEE) and real time two-dimensional transesophageal echocardiography (2DTEE). The 3DTEE provided incremental value on top of 2DTEE in its ability to accurately identify and localize vegetations and in identifying complications of infective endocarditis such as abscesses, perforations, and ruptured chordae. By using 3DTEE, we were able to measure vegetation volumes, perforation areas, and estimate the area of the valve that is involved in the infective process.

Usefulness of live/real time three-dimensional transthoracic echocardiography in diagnosing acquired left ventricular-right atrial communication misdiagnosed as severe pulmonary hypertension by two-dimensional transthoracic echocardiography.

We describe an adult patient with an acquired left ventricular-right atrial communication that was misdiagnosed as severe pulmonary hypertension (PH) by two-dimensional (2D) transthoracic echocardiography, but accurately detected on three-dimensional (3D) transthoracic echocardiography. Open heart surgery confirmed the defect.

Live/real time three-dimensional transthoracic echocardiographic assessment of aortic dissection rupture into right ventricular outflow tract: a case report and review of the literature.

We present a case of chronic ascending thoracic aortic dissection with rupture into the right ventricular outflow tract (RVOT) diagnosed by two-dimensional transthoracic echocardiogram in which live/real time three-dimensional (3D) transthoracic echocardiogram provided incremental value by demonstrating: (a) a tortuous false lumen that encroached and ruptured into the RVOT, (b) exact location of the rupture site in relation to other surrounding structures in 3 dimensions (c) en face view of the rupture site facilitating assessment of its size and shape, and (d) localized compression of the main pulmonary artery (PA) by the false lumen. In addition, cropping of the 3D data set permitted visualization of the origin of the left main coronary in a rapid manner excluding involvement of this vessel with the dissection process. These findings have potential implications for surgical planning and were corroborated by a computed tomography angiogram.

Live/real time three-dimensional transthoracic echocardiographic assessment of pulmonary regurgitation.

There is no gold standard for the measurement of pulmonary regurgitation (PR) severity. Two-dimensional (2D) transthoracic echocardiography is most commonly used to quantify PR severity using color Doppler criteria for aortic regurgitation. However, this method is limited by visualization of only one or two dimensions of the proximal PR jet or vena contracta (VC) precluding accurate assessment of its shape or size.

Comparison of real time two-dimensional with live/real time three-dimensional transesophageal echocardiography in the evaluation of mitral valve prolapse and chordae rupture.

We compared live/real time three-dimensional transesophageal echocardiography (3D TEE) with real time two-dimensional transesophageal echocardiography (2D TEE) in the assessment of individual mitral valve (MV) segment/scallop prolapse and associated chordae rupture in 18 adult patients with a flail MV undergoing surgery for mitral regurgitation. 2D TEE was able to diagnose the prolapsing segment/scallop and associated chordae rupture correctly in only 9 of 18 patients when compared to surgery. In three of these, 2D TEE diagnosed an additional segment/scallop not confirmed at surgery.